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General NPI Number Information
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NPI Number | 1700876075
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Entity Type | Organization
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Legal Business Name | ST MARY PHARMACY INC
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 9720 4TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-8101
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Country | US
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Telephone | 718-921-2525
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Fax | 718-921-5432
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Provider Business Mailing Address
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Address Line | 9720 4TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-8101
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Country | US
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Telephone | 718-921-2525
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Fax | 718-921-5432
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Authorized Official
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Title or Position | OWNER
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Name | RANIA MEKHAIEL
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Credential | RPH
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Telephone | 718-921-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 025838
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License Number State | NY
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